Pancreatic cancer

About 2600 Australians are diagnosed with pancreatic cancer each year. The average age at diagnosis is 72.

Pancreatic cancer was estimated to be the tenth most common cancer in both males and females in Australia during 2014.

The majority (more than 90%) of pancreatic cancers are exocrine tumours.

There are two main types of tumours that occur in the pancreas:

Exocrine tumours

Make up the majority of pancreatic tumours. The most common exocrine tumour, called an adenocarcinoma, begins in the lining of the pancreatic duct. Other types of exocrine tumours include adenosquamous carcinomas and undifferentiated carcinomas. The name of the cancer is taken from the type of cells involved.

Pancreatic NETs (neuroendocrine tumours)

Pancreatic NETs begin in the endocrine cells. These cells produce hormones that control the growth of cells in the body. Pancreatic NETs are categorised as either hormone secreting (functioning) or non-hormone secreting (non-functioning).

Functioning tumours are usually named after the type of hormone they produce.

Types of functioning pancreatic NETs include:

• gastrinomas – produce too much gastrin
• insulinomas – produce too much insulin
• glucagonomas – produce too much glucagon
• somatostatinomas – produce too much somatostatin
• VIPomas – create a hormone-like substance called vasoactive intestinal polypeptide (VIP).

Research has shown that people with certain risk factors are more likely than others to develop pancreatic cancer.

Risk factors include:

• ageing – pancreatic cancer is most common in people aged over 65
• smoking – cigarette smokers are 2–3 times more likely to develop pancreatic cancer
• new onset type 2 diabetes – about 15–20% of people with pancreatic cancer have newly diagnosed diabetes
• pancreatitis – chronic inflammation of the pancreas
• family history and inherited conditions.

Most people with pancreatic cancer do not have a family history of the disease. However, about one in 10 people who develops pancreatic cancer has a faulty gene that can run in families.

You may have an inherited family risk if you have two or more first-degree relatives affected by pancreatic cancer, or a history of an inherited syndrome.

Some inherited syndromes that may increase the risk of pancreatic cancer include Peutz-Jeghers syndrome, the familial breast cancer gene (BRCA1 and BRCA2), familial atypical multiple mole melanoma syndrome, Lynch syndrome and hereditary pancreatitis.

Some pancreatic NETs are caused by a rare inherited syndrome, such as multiple endocrine neoplasia type 1 (MEN-1) or neurofibromatosis.

If you are concerned about your family history or want to know more about genetic testing, talk to your doctor or visit the Australian Familial Pancreatic Cancer Cohort (AFPaCC) website.

The pancreas is part of the digestive system. It produces enzymes that break down food so it can be absorbed and used by the body.

It is a long, irregular shaped gland about 13–15cm long that lies between your stomach and spine.

The pancreas is divided into:

• a large rounded section, called the head of the pancreas
• the middle part, known as the body
• the narrow end, called the tail.

A tube called the pancreatic duct connects the pancreas to the first part of the small bowel (duodenum). Another tube, called the common bile duct, joins with the pancreatic duct and connects the liver and gall bladder to the small bowel. The common bile duct carries bile, a substance that helps to digest fats.

The pancreas contains two types of glands: 

Exocrine glands

These produce juices called enzymes that help break down food. The juices flow through the pancreatic duct from the pancreas into the duodenum. Most of the pancreas is made up of exocrine glands.

Endocrine glands

These are scattered amongst the exocrine glands in small clusters called pancreatic islets (or islets of Langerhans). They release hormones that control the amount of sugar in the blood. The hormone insulin decreases blood sugar levels, while the hormone glucagon increases blood sugar levels.